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Celiac sprue (gluten enteropathy)

Definition: This is a common disease in which the lining of the small intestine is damaged in response to ingestion of gluten and similar proteins, which are found in wheat, rye, oats, barley, and other grains (including hybrid grains, such as triticale).

Other names: Sprue; Nontropical sprue; Gluten intolerance

Celiac sprue is an inflammatory condition caused by intolerance to gluten, a substance found in wheat and other grains. The inability to digest and process this substances may lead to inflammation of the intestines, vitamin deficiencies due to lack of absorption of nutrients, and bowel abnormalities. Gluten may be found in many foods, especially processed foods and baked goods. Breads, cakes, desserts that use thickeners, alcoholic beverages (except wine), cereals and pastas may all contain gluten.

Celiac disease, usually first seen in childhood, involves an intolerance to gluten. Gluten is the protein component in wheat, oats, rye and barley. The cause is not understood; it may involve an immune factor or an inherited mucosal defect. Diagnosis is made by intestinal biopsy and blood work.

The disease can cause the destruction of the intestinal villi (tiny hair-like projections on the interior surface of the small intestine) following the ingestion of gluten-containing products. The results can be a decrease in the absorption of sugars, fat and protein. This causes abnormal stools, due to the fermentation of undigested carbohydrates and excessive amounts of fat in the stool.

If untreated, affected people may show signs of malnutrition: weight loss, growth failure, muscle wasting, peripheral neuritis and prolonged bleeding times.

Food Sources: Fruits and vegetables, meat and fish are good sources of calories for people with celiac disease. Avoid food that are processed and prepared without knowing what they contain and how they were prepared.

foods to avoid

Symptoms in infants and children:

  • Abnormal stools
  • Diarrhea
  • Growth, slow (child 0 to 5 years old)
  • Irritability
  • Bloody or clay-colored, foul-smelling stools
  • Vomiting
  • Weight loss
  • Decreased appetite (anorexia)
  • Muscles in arms and legs are thin and wasted
  • Abdominal distention

Symptoms in adults:

  • Abnormal appearance of the teeth
  • Abdominal distention
  • Abdominal pain
  • Bloating
  • Bone pain
  • Bone tenderness
  • Breathlessness (due to anemia)
  • Depression
  • Diarrhea
  • Fatigue
  • Irritability
  • Muscle cramps
  • Tiredness
  • Vomiting
  • Weight loss

Additional symptoms that may be associated with this disease:

  • Nosebleed
  • Swelling, overall
  • Floating stools

Signs and tests: Typically, most people with celiac disease will have symptoms of malabsorption such as diarrhea. However, some will have bone disease, anemia, or other conditions without diarrhea. Compression fractures of the back, kyphoscoliosis (see scoliosis), or other signs of bone disease may be present. Steatorrhea ("fatty" diarrhea, or stools that can be foul smelling and unusually colored) is common.

Dental examination may show changes in the teeth. In fact, some cases of celiac disease are suspected by a dentist because of the changes in the enamel of the teeth, which include symmetrical (the same on both sides) changes in the tooth color and surface texture.

A CBC often indicates anemia. Two relatively new blood tests have improved the ability to accurately diagnose this disorder: Both the IgA antiendomysial antibody and the antigliadin antibodies are sensitive and specific for the diagnosis of celiac disease.

An EGD (endoscopy) and small bowel biopsy, particularly biopsy of the jejunum (the part of the small intestine most often affected), will show an abnormal intestinal lining. Serial biopsies may be performed before and after a gluten-free diet. Improvement of the findings of biopsy (or improvement of symptoms) after a gluten- and gliadin-free diet is considered highly indicative of celiac disease.

Treatment: A life-long gluten-free diet is required. This allows the intestinal villi to heal. Foods that contain wheat, rye, oats, and barley must be eliminated from the diet. Food and drug labels should be read carefully to look for "hidden" sources of gluten. This often includes the words "vegetable protein" or "plant protein" (such as "tvp" -- textured vegetable protein). Other hidden sources of gluten include grain derivatives such as malt, modified food starch, soy sauce (some types), grain vinegar (or "distilled vinegar"), and some binders, fillers, and flavorings.

Vitamin and mineral supplements may be needed to correct nutritional deficiencies.

Sometimes, corticosteroids (such as prednisone) may also be required.

The stress of a chronic disorder such as celiac disease can sometimes be helped by joining a support group where members share common experiences and problems.

Expectations (prognosis): Untreated, the disorder can cause life-threatening complications. Symptoms usually disappear within several weeks after the person begins a gluten-free diet. The gluten-free diet must be followed continuously or the symptoms will return.

Complications: Vitamin and mineral deficiencies such as rickets and osteomalacia are common complications. Other complications include pancreas disorders, damage to the nerves, infertility, and miscarriage. People with celiac disease may be at a greater risk for lymphoma and intestinal cancers.

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